Page 219 - Creating Spiritual and Psychological Resilience

188 Creating Spiritual and Psychological Resilence

sense that rituals of any kind occur within a mental blind spot. They are
performed for unconscious reasons, representing an ultimately dysfunc-
tional way of managing anxiety over one’s impulses.
Ritual-like behavior also abounds in modern day definitions of psy-
chiatric illnesses, as laid out in the main text of psychiatric diagnosis,
the American Psychiatric Association’s (APA) Diagnostic and Statistical
Manual (2000). Autistic disorder includes engaging in repetitive patterns
of behavior, including “nonfunctional routines or rituals.” Obsessive–
compulsive disorder can include compulsions, which are repetitive behav-
iors or mental acts that could include praying, that the sufferer feels rigidly
driven to perform as a means of allaying their anxieties. Although not
part of the definition of the disorders, proneness to bizarre routines or
rituals may also be seen in psychotic conditions like schizophrenia or a
related condition, schizotypal personality disorder.
Psychiatrists, therefore, typically work within a tradition that is at least
wary of rituals. Ritual and ceremony are largely absent from the prac-
tice of psychiatry (Johson, Feldman, Lubin, & Southwick, 1995). When I
have been asked to participate in ceremonies, such as World Trade Center
Responder Day, it is, therefore, not surprising that I cannot locate any pro-
fessional landmarks from which to launch my involvement. Colleagues
and I have been asked in the past to advise organizers of memorial ser-
vices for events as disparate as aviation disasters or 9/11. But, we are lost
in these circumstances, lacking for expertise to offer and often relegated
to hovering in the shadows of such events as virtual voyeurs seeking pur-
pose in a foreign land. Perhaps not coincidentally, a 2007 study found that,
compared to other physicians, psychiatrists were more likely to describe
themselves as having no religious affiliation, preferred to consider them-
selves “spiritual” rather than “religious,” and are less likely to use religion
to cope (Curlin et al., 2007).

The Evidence

If there were ever a place in which psychiatrists should feel comfort-
able with rituals, however, it is precisely that of disasters. Disasters and
trauma disconnect people from one another and from their past and
future. Routines are destroyed along with lives and cherished belongings.
Questions of purpose and meaning inevitably arise as stricken communi-
ties struggle to find hope amid death and destruction. In the face of these
many psychological challenges, it would seem, then, that rituals should be